We are committed to providing you with treatment of the highest quality and success in diagnosing and resolving your condition. The following is a statement of our Financial Policy which will be made available at the office, which we ask you to please read and sign prior to any consultation and/or treatment.
FULL PAYMENT OR A VERIFIABLE PAYMENT METHOD IS REQUIRED AT THE TIME OF SERVICE. OUR DOCTORS ARE PARTICIPATING PROVIDERS IN MANY INSURANCE PLANS AND NETWORKS. WE ACCEPT CASH, CHECKS, VISA, MASTERCARD, AND AMERICAN EXPRESS.
Please note that as a patient receiving services you are INHERENTLY LIABLE FOR ALL COSTS INCURRED. However, we will attempt to collect from your insurance should we have participation with it.
Due to the changing nature of our economy and insurance policies, we have had to make our collection policy more strict. This is in an effort to keep providing the high quality service that our patients are accustomed to.
If payments are delinquent, a collection service charge will be added to your outstanding balance. All accounts considered delinquent or in Collections will have to be paid or arranged for payment before the next appointment is set.
Making and keeping your appointment is very important to us. As we have to set aside time for your appointment, we ask that you kindly call us at least 24 hours in advance for cancellation. Should you not show or cancel on the same day of your appointment a nominal fee of $50.00 will be billed. Your cooperation and understanding will be appreciated. All new self paying patients will be required to provide credit card information when making their appointment.
Our doctors are Participants of the Medicare Program. We accept assignment by Medicare and abide by the Medicare regulations. This also means that responsibility assigned by Medicare (any co-insurance and deductibles) will be collected. We will electronically submit your claims to Medicare for payment of the services provided. Medicare will furnish you with an explanation of medical benefits so that you can then submit these to your secondary insurance plan if our office has no contract with your secondary plan. In the event that Medicare does not pay for a specific service we will appeal directly for the correct reimbursement. You will not be deemed responsible for payment unless Medicare in their statement denies the appeal. In this instance, payment from you is expected upon receipt of our bill. Should a service be known to be non payable by medicare in advance, you will be provided with an Advance Beneficiary Notice listing which service as well as the costs you will be responsible for. These fees will be collected at the time of service.
To benefit from our participation in your insurance network or insurance company a valid insurance identification card must be presented at every appointment. Failure to do so will automatically make you responsible for payment (credit card) at the time of your visit or procedure. If we are a participating provider in your insurance plan, co-payments are payable at the time of service as stipulated by your policy. To minimize your out of pocket expenses you must provide our office with any referrals or authorization forms or numbers as required by your Managed Care contract. If you do not, you will be required to pay at the time of service as a “Private Insurance” patient. If your insurance does not cover a particular service in our office and you desire that service anyway you will be required to pay at the time of service. Your will sign an Insurance Waiver to this end and this waives your right to submit it to your insurance carrier for this service.
PRIVATE INSURANCE (OUT OF NETWORK):
Your insurance policy is a contract between you and your insurance company. We are not a party to that contract. Patients are therefore responsible for full payment at the time of service. Surgical fees are to be paid partially prior to surgical procedure or according to prior agreement, otherwise payment is due upon receipt of statement. If your insurance plan denies reimbursement, our office will provide you with the appropriate documents for your appeal, please be sure to furnish your insurance denial statement if this happens.